First Evangelical Free Church CONFIDENTIAL Pre Wedding Pastoral Counseling Form ANY COUPLE that would like to be married by a pastor in our churc

Document Sample
First Evangelical Free Church CONFIDENTIAL Pre Wedding Pastoral Counseling Form ANY COUPLE that would like to be married by a pastor in our churc Powered By Docstoc
					                                          First Evangelical Free Church

        CONFIDENTIAL Pre-Wedding Pastoral Counseling Form
 ANY COUPLE that would like to be married by a pastor in our church OR who would like to use
  our church for their wedding ceremony, must FIRST turn in this form and have a preliminary
                                meeting with Pastor Mayberry.
            To schedule your preliminary meeting, please call and set up an appointment
                        with Annie Walters in the church office (634-3144) .
Prior to the preliminary meeting, the following form must be filled out in detail BY BOTH THE MAN AND
THE WOMAN and returned to the church office at least 48 hours PRIOR to the scheduled meeting. This
form can be faxed (634-7933) , emailed ( , mailed to the church office (3022 W.
         Fontanero, Colorado Springs, 80904) or given to Pastor Mayberry at a Sunday service.

   1. Do you have a personal connection to our church? ( ) No ( ) Yes If yes, what is the connection:
      I have been attending the church for ________ months / years. OR I have a family member that
      regularly attends the church? (Their name/s:__________________________________
      Your relationship to them:_________________________)
   2. Are you both willing to fill out this confidential and detailed pre-marital counseling form and
      participate in a session with the pastor to discuss the information on these forms? ( ) No ( ) Yes
   3. If a wedding date is approved, are you willing to go through at least 3 more pre-marital counseling
      session with a pastor (of your choice) , counselor, or leader in the church? ( ) No ( ) Yes
   4. Is your desired wedding date at least 4 months or more from today? ( ) No ( ) Yes
   5. Are you currently living (or willing* to live) separately until you are married? ( ) No ( ) Yes
   6. Are you currently refraining (or willing* to refrain) from sexual involvement until your wedding
      night? ( ) No ( ) Yes

*In order to enter into a God-honoring Christian marriage relationship, if you are currently living together AND/OR
are sexually active with each other, we would ask that you agree to live separately AND/OR refrain from further
sexual activity until your wedding night in order to focus your attention and energies on building a God-honoring
relationship during your engagement period and a firmer foundation for your future marriage. Note: If you are
currently living together and feel it would be too much of a financial hardship to live separately, the church is
willing to try to help you find a suitable short-term affordable living situation with a person, couple or family in the

If you answered YES to all 6 questions above, we invite you to proceed with filling out and turning in this pre-
martial counseling form. In order to best serve you for pre-marital pastoral counseling and a Christian wedding
ceremony, the following practical and personal information will be extremely helpful. If there is anything you are
uncomfortable answering in writing, please leave it blank and it can be discussed on a personal basis with the
pastor. Completed surveys MUST BE RECEIVED from both the man and the woman, prior to the preliminary
pastoral meeting. At the close of the preliminary session, the pastor will share with you if he is willing to perform
your wedding ceremony in our church in addition to leading you through three (3) more pre-marital counseling
visits. If you are seeking to use our church facility for your wedding, but have someone else who can perform the
ceremony and/or pre-marital counseling, the pastor will decide at the end of this meeting if you can use our
church for your wedding ceremony. Pre-marital counseling will cover spiritual foundations for a Christian
marriage and family, temperament/personality assessments, finances and wedding plans.
                                  Note: Each person is to fill out their own form.
1st choice of a desired wedding ceremony? Date:_____________ Time: _________AM or PM

2nd choice of a desired wedding ceremony? Date:_____________ Time: _________AM or PM

Who would you like to perform your wedding ceremony? □ Brian Kluth or □________________________________

Who would you like to handle your pre-marital counseling? □Brian Kluth or □_____________________________

Where would you like your wedding ceremony to take place? □At First Evangelical Free Church □At the following location or
church:__________________________________ in (city) :_____________________________.

Name:________________________________________ Birth Date:___________________ Current Age:_________

Full address:___________________________________ City/State:____________________________ Zip:___________

Home Phone:_________________________ Work Phone:_________________ Ext:______ Fax:________________

Cell Phone:________________________________ E-mail address:_______________________________________

In my current housing situation, I am living... ( ) Alone ( ) With roommate(s) ( ) With Family ( ) With my fiancée

Current Marital Status: ( ) Single, Never Previously Married ( ) Single, Divorced ( ) Single, Widowed ( ) Other:__________

If you were previously married...

On what grounds/basis did the marriage dissolve/end?_____________________________ Date?____________

Is your former spouse: ( ) Still Unmarried ( ) Remarried

Is the relationship with your former spouse: ( ) Non-existent ( ) Hostile ( ) Difficult ( ) Cordial ( ) Friendly

For engaged individuals who currently have children from this relationship or a previous relationship:

First Name Last Name (if different than yours) Sex Age Grade (K-12) Custody

___________________ ____________________________ ( ) M ( ) F ______ ______ ( ) Full ( ) Partial ( ) None

___________________ ____________________________ ( ) M ( ) F ______ ______ ( ) Full ( ) Partial ( ) None

___________________ ____________________________ ( ) M ( ) F ______ ______ ( ) Full ( ) Partial ( ) None

( ) Full-time employment as: ________________________________ Name of company:___________________________

( ) Part-time employment as:________________________________ Name of company:___________________________

( ) Self-employed as:_________________________________

( ) Student at ________________________________ Will graduate (year) :___________
( ) Currently unemployed

( ) Full-time homemaker, formerly employed as a:_______________________________

( ) Retired. Formerly employed as:____________________________ Name of company:___________________________

( ) Other:_____________________________________

( ) Currently in High School ( ) High School Graduate ( ) Some College

( ) Tech/Trade/Community College Grad. Degree in: __________________________ from which school:
________________________ (State:____)

( ) College Graduate. Degree in ______________________ from which school:________________________________

( ) Masters or Advanced Degree in: ___________________ from which school:_______________________________

( ) Doctorate in: ________________________ from which school:_____________________________ (State:____)

                                                   Church Background
( ) I started attending 1st Evangelical Free Church in (year) :_______________ If within last year, which month?________

( ) I attend Sunday services at the 1st Evangelical Free Church: ( ) Regularly ( ) Sometimes ( ) Special occasions ( ) Not at all

( ) Reason for sporadic, infrequent or non-existent attendance:______________________________________________

My fiancé attends Sunday services at 1st Free Church: ( ) Regularly ( ) Sometimes ( ) Special occasions ( ) Not at all

Reason for sporadic, infrequent or non-existent attendance:______________________________________________

As a child, I grew up: ( ) Not attending church ( ) Attending church a few times a year ( ) Attending church semi-regularly ( )
Attending church regularly

The 3 previous churches where I have attended include:

Church Name: Denomination: City/State: Year(s) : Pastor's Name:



                                                      Spiritual Journey
Which of the following do you feel best describes where you are in your spiritual journey with Jesus Christ?

        ( ) #1 - Little or no religious background: I seldom or never attended church while growing up. I have little
        or no knowledge of the Bible and what it means to be a Christian.

        ( ) #2 - Somewhat religious: I grew up attending church on a fairly regular or occasional basis. I have a
        basic understanding of some of the Bible stories and consider myself to be a Christian. I have a concept of
        God in my life, but for the most part I live my life according to what I think or feel is best for me. If I died
        today, I would hope to go to heaven but I am uncertain if a person can know with 100% confidence that they
        will go to heaven when they die.

        ( ) 3 - Spiritual Seeker: I feel I am at a point in my life where I have a genuine desire to have a better
        understanding of the Bible, Jesus Christ and the Christian faith. I am still investigating Biblical Christianity
        and I am open to God becoming more real to me. I have not yet fully yielded my life to Jesus Christ and I
        have not yet put my trust in Him to forgive all my sins. If someone asked me if I have been "born again", I
        would say "no" or I would not be sure what they were talking about.

        The thing(s) I feel are holding me back from yielding and giving my life fully to the Lord are:

        Note: The pastor will be happy to help you resolve your spiritual questions and concerns so that you can
        become a follower of Jesus Christ.

        ( ) 4 - Backsliding Christian believer: In the past (approximate age(s) :__________) , I had a genuine love
        for God and had asked Jesus Christ to be my personal Lord and Savior. In recent years, I have been out of
        fellowship with the Lord, have not been active in a Bible-believing church, have not developed or maintained
        close Christian friendships, and have spent little or no time in the Bible.

        ( ) 5 - New/Young/Recommitted Christian Believer: I have recently become a born-again Christian and I
        am excited about my new relationship with Jesus Christ OR I have been a born-again Christian for a long-
        time, but am only recently discovering God's deep love for me and His desire to work in and through my life.

        ( ) 6 - Stable/Growing Christian Believer: I am confident of God's active working and leading in my life. I
        look to Him and His word on a regular basis. I am regularly involved on a weekly basis in a Bible-believing
        church and I look for ways to serve the Lord and others

        ( ) 7 - Mature Christian Believer: I have a deep and consistent walk with the Lord. I am actively attending
        and serving on a weekly basis in a Bible-believing church. I understand my spiritual giftedness and actively
        use my time, gifts and resources to influence others for the Lord.

For those who checked #4, #5, #6 or #7: How and when did you come to know Jesus Christ personally?




For those who checked #5, #6 or #7: What do you currently do to actively maintain your relationship with the Lord?





                                                    Family Background
During your growing up years, who raised you:

( ) Natural parents ( ) Single parent: ( ) mom ( ) dad ( ) 1 Natural/1 step parent ( ) Adoptive parents ( ) Relatives

How would you rate your growing up years:

Pre-School: ( ) Happy ( ) Okay ( ) Difficult Because:__________________________________________________

Primary School: ( ) Happy ( ) Okay ( ) Difficult Because:_______________________________________________

Middle School/Jr High: ( ) Happy ( ) Okay ( ) Difficult Because:_________________________________________

High School: ( ) Happy ( ) Okay ( ) Difficult Because:_________________________________________________

College-age: ( ) Happy ( ) Okay ( ) Difficult Because:_________________________________________________

# of siblings:____ In birth order, which # are you (#1 being the oldest) :_____ # of brothers:_____ # of sisters:_____

If your parent(s) are still living, where are they living? (City/s, State/s) :____________________________________

What was the primary profession/vocation of your (dad) :___________________, (mother) :__________________

List up to 4 Cities/States where you lived while growing up (indicate approximate # of years in that area) :
___________________________,_______/_______yrs. ___________________________,_______/_______yrs.

___________________________,_______/_______yrs. ___________________________,_______/_______yrs.

Were any of your parents or siblings?: ( ) Physically abusive ( ) Verbally abusive ( ) Sexually abusive ( ) Alcoholics ( ) Drug
users ( ) None Comments:________________________________________________

What was the religious faith of your parents?

Father:______________________ Was he... ( ) Strong ( ) Moderate ( ) Nominal ( ) Non-existent his faith practices?

Mother:_____________________ Was she... ( ) Strong ( ) Moderate ( ) Nominal ( ) Non-existent her faith practices?

Who in your lifetime has had the greatest spiritual influence on your faith in
                                                      Personal Issues
How long have you known your fiancée?:___________ How long have you been actively dating?:____________

How would you describe the pulse of your relationship during your dating/engagement period:

( ) Heaven on earth ( ) Happy ( ) Okay ( ) Rocky - up & down ( ) Very Difficult

How do your parents feel about your marriage to your fiancée?: ( ) Excited ( ) Accepting ( ) Questioning ( ) Against

How do your future in-laws feel about your marriage to your fiancée?: ( ) Excited ( ) Accepting ( ) Questioning ( ) Against

How do your 1-3 closest personal friends feel about your marriage to your fiancée?: ( ) Excited ( ) Accepting ( ) Questioning (
) Against

Have you ever taken any temperament/personality tests to see how you compare/contrast to your fiancee's

( ) No ( ) Yes -- (If you know, what was the name of the test assessment you took?:________________________________)

How would you describe your sexual relationship up until this point?:

( ) Saving yourselves sexually for marriage. ( ) Physically/sexually involved with each other. ( ) Have lived or are currently
living together.

Are there any secrets you are holding in and you feel that if your fiancée found out, you would be afraid they might call off the
wedding? ( ) No ( ) Yes If yes, are you willing to discuss this during the pre-marital counseling session? ( ) Yes ( ) No

Have you ever been treated for depression? ( ) No ( ) Yes. Year(s) treated:__________

Have you ever attempted suicide? ( ) No ( ) Yes. Year:______

Have you ever had any homosexual experiences? ( ) None ( ) One time in the past. ( ) Some encounters in the past. ( )
Numerous encounters in the past ( ) Currently involved

Have you ever...?: ( ) Used drugs (type/s:________________) ( ) Had a drinking problem ( ) Been arrested ( ) Been in jail ( )
None of these

Have you ever...? ( ) Prayed aloud together ( ) Read/discussed the Bible together ( ) Attended a Bible study group together ( )
None of these

Have you discussed in detail the issue of children (timing of children and the number of children you desire) ? ( ) No ( ) Yes

In the past, when I have gotten in disagreements or arguments with a loved one or family member, I have: ( ) Screamed ( )
Clammed up and refused to talk ( ) Covered up my true feeling ( ) Lied about my feelings ( ) Blamed everything on the other
person ( ) Gave the person the silent treatment for _____ hours OR _____ days ( ) Punched them ( ) Hurt them ( ) Promised
to get even ( ) Called them bad names ( ) Flew into a rage ( ) Threw things or broke things ( ) Pouted ( ) Prayed with them
about the problem/issue ( ) Gotten a 3rd party to help us work through the problem/issue ( ) Calmed myself down so the
problem could be discussed and resolved ( ) Brought up old issues from the past ( ) Walked out of the room ( ) Slammed
doors ( ) Left the house mad ( ) Got drunk ( ) Went shopping

Are there any significant health problems you are bringing into the marriage? ( ) No ( ) Yes. Explain:
Are there any financial debts that you bring into the marriage?

( ) Student loans of $_________ ( ) Unpaid credit card bills of $________ ( ) Unpaid medical bills of $_________

( ) Personal or family loans of $__________ ( ) Monthly car payment of $________ ( ) Mortgage of $_________

( ) Other debts/loans of $_________ for ____________________; $_________ for ____________________

Check any and all words that describe your financial attitudes and habits: ( ) Spender ( ) Shopper ( ) Saver ( ) Out of control (
) Orderly ( ) In debt ( ) Spend less than I make ( ) Spend more than I make ( ) Pack rat ( ) Throw out or give away what I'm
not using ( ) Generous ( ) Tither ( ) Extravagant ( ) Parents spoiled me ( ) Parents deprived me ( ) Parents trained me in
financial matters ( ) My family argued about money issues ( ) Greedy ( ) Simple pleasures/tastes ( ) Rich pleasures/tastes ( )
Tight ( ) Investor ( ) Financially clueless ( ) Operate on a budget-spending-savings plan ( ) Live for the moment ( ) Impulsive
shopper ( ) Careful shopper ( ) Bargain hunter ( ) Thrifty ( ) I have more month than money ( ) I have money in the bank ( )
Have attended a Bible Study or Christian seminar on financial matters ( ) Garage sale & thrift store shopper ( ) Ebay shopper
( ) On-line shopper ( ) Walmart or K-Mart shopper ( ) Boutiques or department store shopper ( ) Compare prices ( ) Don't
even notice prices

Have you and your fiancée worked together to develop a written household income/spending plan for your new marriage? ( )
Yes ( ) No

Are there any fears, concerns or apprehensions you currently have about your future marriage to your fiancée?

( ) No ( ) Yes. Item(s) : ________________________________________________________________________________

Are you willing to go through 3 or 4 pre-marital counseling sessions PRIOR to your wedding ceremony to assess and work on
your spiritual foundations as a couple, your personality make-up, your financial plans and your wedding ceremony plans? ( )
Yes ( ) No If yes, who would you like to do this with: ( ) Brian Kluth OR ( ) Name of person:____________________ ( ) Pastor
( ) Counselor ( ) Mature Christian

In pre-marital counseling, are you willing to faithfully complete any given reading, test assessments or home work
assignments? ( ) Yes ( ) No Are you financially able to pay for $60-$75 (per couple) in reading and test assessment
materials? ( ) Yes ( ) No

                                             For Office Use Only
Preliminary meeting by Pastor on ____/____/____                    Name:__________________________

Approved for a wedding ceremony at our church on ____/____/____ at ____am/pm to be officiating by:
__________________________ (phone number:_______________) .

Pre-marital counseling is to take place by: __________________________________ (phone

Mailing address:_________________________________________________) .

Tentative dates for pre-marital counseling would

OR the following alternative steps are recommended:



Description: Pre Marriage Counseling Blank Forms document sample